Heart Palpitations: Is It Anxiety or Autonomic Dysfunction?

Cardiac discomfort. Autonomic nervous system dysfunction?

Hello, doctor.
I was diagnosed with mitral valve prolapse since childhood, but it hasn't been serious, and I don't need to take medication.
I've had symptoms like palpitations and shortness of breath since I was young, but I've managed to grow up with them.
Four years ago, I started experiencing premature beats (premature contractions?), and during severe episodes, I would have more than 10 missed beats per minute.
I went to the hospital for a cardiac ultrasound and a stress test, and the doctors said there was nothing significant.
Since then, I've often dealt with various heart discomforts, including palpitations, missed beats, forceful heartbeat, rapid heartbeat, shortness of breath, chest tightness, and a feeling of constriction in my chest.
Mild symptoms usually resolve with a bit of rest, but more pronounced discomfort can lead me to feel down and anxious, affecting my quality of life and mood.
Recently, over the past week, the discomfort has intensified, with my heart rate rising to 110 in the morning or after meals, often accompanied by premature beats and dizziness.
After a "battle" with these symptoms, I often feel fatigued and lack appetite for the entire day.
I would like to ask the doctor: 1.
Do I need to undergo further cardiac examinations? (The last stress test was in April 2021, and the cardiac ultrasound was in 2018, both showing no significant issues.) 2.
Should I consider that my symptoms may not be due to an organic heart problem, but rather autonomic nervous system dysregulation? Thank you.

Xiao Lin, 30~39 year old female. Ask Date: 2021/10/08

Dr. He Dongjin reply Cardiology

Hello, that's correct.
You have autonomic nervous system dysfunction, not an organic heart problem.
There is no need for further cardiac examinations or to see a cardiologist or psychosomatic specialist.
Simple medications can help improve your symptoms.
Don't worry, Changhua Hospital cares about you.

Reply Date: 2021/10/08

More Info

Understanding heart palpitations can be quite complex, especially when they are intertwined with anxiety and autonomic dysfunction. Based on your description, it seems you have a history of mitral valve prolapse, which is often benign but can be associated with symptoms like palpitations, shortness of breath, and anxiety. Your experience of heart palpitations, especially with episodes of premature beats (PVCs), is not uncommon among individuals with this condition.

1. Need for Further Cardiac Evaluation: Given that your last cardiac evaluations were in 2021 and 2018, and considering the recent increase in your symptoms, it may be prudent to undergo another round of cardiac testing. This could include a repeat echocardiogram and possibly a Holter monitor to assess the frequency and nature of your palpitations over a 24-hour period. While previous tests indicated no significant issues, the persistence and worsening of your symptoms warrant a fresh look to rule out any new developments or changes in your heart's function.

2. Anxiety vs. Autonomic Dysfunction: Your symptoms, including palpitations, dizziness, and feelings of tightness in the chest, can indeed be influenced by both anxiety and autonomic dysfunction. The autonomic nervous system regulates involuntary bodily functions, including heart rate and blood pressure. When this system is out of balance, it can lead to symptoms like palpitations and shortness of breath. Anxiety can exacerbate these symptoms, creating a cycle where anxiety leads to physical symptoms, which in turn increases anxiety.

It's essential to recognize that while your heart may not have significant structural issues, the way your body responds to stress and anxiety can significantly impact your quality of life. Many individuals with similar histories find that their symptoms improve with lifestyle modifications, such as regular exercise, stress management techniques (like mindfulness or cognitive behavioral therapy), and adequate sleep.
Management Strategies:
- Lifestyle Modifications: Regular aerobic exercise can help improve autonomic regulation and reduce anxiety. Aim for at least 150 minutes of moderate exercise per week, as tolerated.

- Stress Management: Techniques such as deep breathing exercises, yoga, or meditation can help manage anxiety and reduce the frequency of palpitations.

- Dietary Considerations: Avoiding stimulants like caffeine and nicotine can also help reduce palpitations. Maintaining a balanced diet can support overall cardiovascular health.

- Medication: If anxiety is significantly impacting your daily life, discussing the possibility of medication with your healthcare provider may be beneficial. Beta-blockers, for example, can help manage palpitations and anxiety symptoms.

In summary, while your symptoms may not indicate a severe cardiac issue, they are certainly affecting your quality of life. A comprehensive approach that includes further cardiac evaluation, lifestyle changes, and possibly psychological support can help you manage these symptoms more effectively. Always consult with your healthcare provider before making any changes to your treatment plan.

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